EXCLUSIVE: Health Insurance reveals cancer drug postcode lottery

However, all three insurers pointed out that some limitations apply. Members may choose a policy that excludes cancer or will cover a limited period of treatment. Fergus Craig, commercial director at AXA PPP healthcare, said that most AXA customers selected a policy that would pay for cancer treatment up to 12 months. Aviva covers targeted drug therapies treatment for up to 12 months per condition although corporate customers can increase this to three years, reduce it to six months or exclude targeted drug therapies altogether.

Like PCTs, they may also turn down requests to use drugs outside the terms of their licence (see ‘Why do cancer patients’ box opposite). Dr Doug Wright, principal clinical consultant at Aviva UK Health, said such requests would be decided on a “case by case basis”.

“It may be a very rare tumour which can only respond to a certain drug,” he explained. “In this case, our clinical team will research the options fully and may well recommend cover outside of the licensing.”

Claims for cancer drugs are a growing cost for private medical insurers. AXA PPP healthcare spent £16m on just two drugs (Herceptin and Avastin) in 2009 and £35m overall while Bupa’s spending on cancer has gone up 40% in five years, much as result of funding targeted therapies.

We asked England’s 152 primary care trusts – the organisations which hold NHS budgets at a local level and commission services – the following questions under the Freedom of Information Act and 122 responded. We asked:

1. HOW MANY EXCEPTIONAL CASE FUNDING REQUESTS IN 2009 RELATED TO CANCER DRUGS?

2. WHAT PERCENTAGE OF THESE REQUESTS WERE GRANTED?

The funding of new cancer treatments was raised onto the political agenda in the build-up to the general election. The Conservative Party has proposed removing the power to make decisions on the funding of off-label drugs from PCTs and passing it to clinical experts at strategic health authorities (NHS bodies responsible for large regions of England). It has also proposed establishing a £200m Cancer Drugs Fund which it claims will ensure that no cancer patient is refused access to drugs that have been licensed since 2005 and recommended by their doctor. In the long-term it has pledged to reform the way pharmaceutical companies are paid for drugs.

1. Their doctor may prescribe a drug without a licence Most new cancer drugs must be licensed by the European Medicines Agency, which assesses their safety and efficacy. Until a new drug is licensed it cannot be assessed by NICE or widely prescribed within the NHS. The licence will be for a specific use of the drug, for example, to treat a particular form of cancer. However, a doctor may recommend an “off-label” use of the drug. For example, he may wish to use it to treat a different kind of cancer.

2. NICE may not yet have issued guidance on the drug Once NICE has issued guidance on a drug, PCTs have three months in which to make funding available to implement it. However, there is a time lag between a drug being licensed and NICE producing guidance. The government has said that in 2010 this should be reduced to six months.

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